Genital ulcer D dx infective (HSV, primaty syphilis,LGV, chancroid,,HIV) non infective(apthus,trauma,skin disease,Behcet disease,dermatosis) HSV TYPE 1 CAUSE ORAL LESION Type 2 cause genital. 50% of genital caused by type 1 Primary infection present 3 wks after acquision of virus with wide spread involvement of the vulva, vx,and cx.painful vesicle develop—unite—multiple ulcers.

Periurethral involvement may cause urinary retension and this may also be partly due to sacral n involvement.if seen very early primary HSV may only affect a smaal part of the vulva(confused as recurrence) and the coarse of antivirus for 5 days may be effective The dx confirmed by taking serum from the vesicle with small gauge needle and syringe or by cotton swab and examned under microscope Treatment Analgesia and bathing in salt water Llignocaine gel on sore area,antiviral acyclovir 200 mg 5 times daily for 5 days,other antiviral like famciclover and valaciclover have greater bioavailability but are expensive.

Recurrent herps HSV colonise the dorsal root ganglion and establish a latent infection producing infectionintermittently along the axons to the skin.vesicles and ulcers then occur usually occur in the same area. Recurrent infection may be asym. :trivial ulcer resembling small abrasion, :localized clusters of vesicles and ulcers over an area of 1-2 cm :in pregnancy and decreased immunity – large and wide spread infection Treatment of recurrence :antivirus is not helpful,female advise to clean the area and avoid sex.contact

Those with frequent recurrence more than 6-8 /year kept on long term suppression with acyclovir 400mg twice /day Complication of HSV: 1- psychological distress(LIFE LONG INFECTION) 2-aseptic meningitis 3-herpetic kertitis and blidness 4-vertical transmission to the fetus SYPHILIS:SYSTEMIC DISEASE,STD, caused by treponema pallidum The first manefistation of venereal syphilis is PAINLESS ULACER (chancre) at the site of inoculation,it is usually single but can be multiple.

The regional L.N enlarge,in female the commonest site for chncre is the cx it may therefore unnoticed.a chncre usually arise 3-6 wks after infection,painless and resolve without treatment.chancre usually had rubbery consistancy.--- Secondary s. can arise as the chancre disappear or up to 6 months later.this is manifested by systemic eruption (palm and sole ) maculopapular rash and non itchy.mucus patches and linear ulcers (snail track) are seen on the mucosal surfaces.generalized LAP,alopecia,arthritis,meningitis. Aafter many years neurosyphilis develop.

Dx:dark field microscopy(spiral organism move and bend in special pattern Serologic test:FTA(fluorscent treponaemal ab test this is most sensitive test. TPHA(trep.pal.haemagglutination test VDRL these test may be –ve in early disease.in secondary s. the serologic test are +ve Treatment: Procaine pencillin 1.2 million unit daily i.m for 12 days Benzathine pencillin 2.4 mu i.m repeated after 1 wk. Doxycyclin 100mg *2 for 14 days Erythromycin 500*4 for 14 days

Other d.dx ----read in the book Warty lesion: Human papilloma virus :certain strain of HPV infect the genital area and are STD. the virus can infect the prrineum,vx,vulva,cx and rectum.warts are frequently multiple and slowly growing and can spread directly to the perianal skin.majority of genital warts caused by types (6,11)less oncogenic than (16,18)causing flat wart and linked to ca cx. Treatment:cryotherapy Application of podophyllin once or twice /wk up to 6 wks.cure rate 60%.purified extract of podophyllotoxin twice/d for 3 days with application of petrollium jelly to near by skun.surgical treatment for intractable cases:laser,electrocautary,or scissor excision.

Molluscum contagiosum: Pox virus causing painless pearl shape lesion with a dimple in,the middle up to 5 mm in diameter.common in childhood and clear after few months.adult acquire the infection by STD infection resolve with cryoyherapy, currete,application of phenol. HIV IN GYNAE.: HIV is a retrovirus, single stranded RNA,it suppress cell mediated immunity,mainly transmitted by intercourse. Gynaecologic manifestations: 1-HPV flourish and genital warts persist despite aggressive treatment. 2-persistant HPV –cervical ca, VIN 3-increase postpartum endometritis 4-wide spread and severe secondary HSV. 5-PID needs longer coarse of AB.

TUBERCULOSIS: mycobacterium can spread to the genital organ via blood sream or through lymphatics.ther is always TB else where us pulmonary.granuloma develop in the fallopian tube (100% involvement of the tube ) and then to other genital organs.infection may remain subclinical and presenting as amenorrhoea,infertility,or PID,.ENDOMETRIUM involved in 80%, ovaries 20-30%,abnormal uterine bleeding in 10-40%. ex,. Normal in many females but an adenxial mass or fixation of pelvic organs may be detected.dx.can be confirmed by D&C during the secretory phase and sending the sample in N/S. Treatment :anti TB